APPENDIX A: DSM-IV-TR diagnostic criteria for ADHD (2023)

69

70 Impulsivity

(f) often blurts out answers before questions have been completed (g) often has difficulty awaiting turn

(h) often interrupts or intrudes on others (e.g., butts into conversations or games)

(B) Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.

(C) Some impairment from the symptoms is present in two or more settings (e.g., at school (or work) and at home).

(D) There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

(E) The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

Code based on type:

341.01 Attention-Deficit/Hyperactivity Disorder, Combined Type: if both criteria A1and A2 are met for the past 6 months

314.00 Attention-Deficit/Hyperactivity Disorder, predominantly Inattentive Type: if criterion A1is met but criterion A2 is not met for the past 6 months

314.01 Attention-Deficit/Hyperactivity Disorder, predominantly Hyperactive-impulsive Type: if criterion A2 is met but criterion A1 is not met for the past 6 months

Code note: for individuals (especially adolescents and adults) who currently have symptoms that no longer meet full criteria, “In Partial Remission” should be specified.

314.9 Attention-Deficit/Hyperactivity Disorder not otherwise specified

This category is for disorders with prominent symptoms of inattention or hyperactivity-impulsivity that do not meet criteria for Attention-Deficit/Hyperactivity Disorder.

71 Examples include

1. Individuals whose symptoms and impairment meet the criteria for Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive type but whose age at onset is 7 years or after

2. Individuals with clinically significant impairment who present with inattention and whose symptom pattern does not meet the full criteria for the disorder but have a behavioral pattern marked by sluggishness, daydreaming, and

hypoactivity

72 13.0 Appendix B: ICD-10 criteria for ADHD

ICD-10 research criteria for diagnosis of F90 – F98. Behavioral and emotional disorders with onset usually occurring in childhood and adolescence.

F90. Hyperkinetic disorders.

Note: The research diagnosis of hyperkinetic disorder requires the definite presence of abnormal levels of inattention, hyperactivity, and restlessness that are pervasive across situations and persistent over time and that are not caused by other disorders such as autism or affective disorders.

Eventually, assessment instruments should develop to the point where it is possible to take a quantitative cut-off score on reliable valid and standardized measures of hyperactive behavior in the home and classroom, corresponding to the 95^th percentile on both measures. Such criteria would then replace G1 and G2 below.

G1. Demonstrable abnormality of attention, activity and impulsivity at home, for the age and developmental level of the child, as evidenced by (1), (2) and (3):

(1) At least three of the following attention problems:

(a) Short duration of spontaneous activities;

(b) Often leaving play activities unfinished;

(c) Over-frequent changes between activities;

(d) Undue lack of persistence at tasks set by adults;

(e) Unduly high distractibility during study e.g. homework or reading assignment.

(2) Plus at least three of the following activity problems:

(a) Very often runs about or climbs excessively in situations where it is inappropriate; seems unable to remain still;

(b) Markedly excessive fidgeting & wriggling during spontaneous activities;

(c) Markedly excessive activity in situations expecting relative stillness (e.g., mealtimes, travel, visiting, church);

(d) Often leaves seat in classroom or other situations when remaining seated is expected;

(e) Often has difficulty playing quietly.

73

(3) Plus at least one of the following impulsivity problems:

(a) Often has difficulty awaiting turns in games or group situations;

(b) Often interrupts or intrudes on others (e.g., butts in to others’ conversations or games);

(c) Often blurts out answers to questions before questions have been completed.

G2. Demonstrable abnormality of attention and activity at school or nursery (if applicable), for the age and developmental level of the child, as evidenced by both (1) and (2):

(1) At least two of the following attention problems:

(a) Undue lack of persistence at tasks;

(b) Unduly high distractibility, i.e., often orienting towards extrinsic stimuli;

(c) Over-frequent changes between activities when choice is allowed;

(d) Excessively short durations of play activities.

(2) And by at least three of following activity problems:

(a) Continuous (or almost continuous) and excessive motor restlessness (running, jumping, etc.) in situations allowing free activity;

(b) Markedly excessive fidgeting and wriggling in structured situations;

(c) Excessive levels of off-task activity during tasks;

(d) Unduly often out of seat when required to be sitting;

(e) Often has difficulty playing quietly.

G3. Directly observed abnormality of attention or activity. This must be excessive for the child’s age and developmental level. The evidence may be any of the following:

(1) Direct observation of the criteria in G1 or G2 above, i.e., not solely the report of parent or teacher;

(2) Observation of abnormal levels of motor activity, or off-task behavior, or lack of persistence in activities, in a setting outside home or school (e.g., clinic or laboratory).

(3) Significant impairment of performance on psychometric tests of attention.

G4. Does not meet criteria for pervasive developmental disorder (F84), mania (F30), depressive (F32) or anxiety disorder (F41).

G5. Onset before the age of seven years.

G6. Durations of at least six months.

74 G7. IQ above 50.

F90.0 Disturbance of activity and attention

The general criteria for hyperkinetic disorder (F90) must be met, but not those for conduct disorders (F91).

F90.1 Hyperkinetic conduct disorder

Both the general criteria for hyperkinetic disorder (-f90) and conduct disorder (F91) must be met.

F90.8 Other hyperkinetic disorders

F90.9 Hyperkinetic disorder, unspecified

This residual category is not recommended and should be used only when there is a lack of differentiation between F90.0 and F90.1 but the overall criteria for F90.- are fulfilled.

75

Alternative F90 Hyperkinetic disorder (diagnostic criteria for research):

G 1. Inattention. At least six of the following symptoms of inattention have persisted for at least six months, to a degree that is maladaptive and inconsistent with the developmental level of the child:

(a) Often fails to give close attention to details, or makes careless errors in schoolwork, work, or other activities;

(b) Often fails to sustain attention in tasks or play activities;

(c) Often appears not to listen to what is being said to him or her;

(d) Often fails to follow through on instructions or to finish schoolwork, chores, or duties in the workplace (not because of oppositional behavior or failure to understand instructions);

(e) Is often impaired in organizing tasks and activities;

(f) Often avoids or strongly dislikes tasks, such as homework, that require sustained mental effort;

(g) Often loses things necessary for certain tasks or activities, such as school assignments, pencils, books, toys, or tools;

(h) Is often easily distracted by external stimuli;

(i) Is often forgetful in the course of daily activities.

G 2. Hyperactivity. At least three of the following symptoms of hyperactivity have persisted for at least 6 months, to a degree that is maladaptive and inconsistent with the developmental level of the child:

(a) Often fidgets with hands or feet or squirms on seat;

(b) Leaves seat in classroom or in other situations in which remaining seated is expected;

(c) Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, only feelings of restlessness may be present);

(d) Is often unduly noisy in playing or has difficulty in engaging quietly in leisure activities;

(e) Exhibits a persistent pattern of excessive motor activity that is not substantially modified by social context or demands.